Blank for insurance accounting



TI C. PARSONS.`

BLANK FOR INSURANCE ACCOUNTING.

APPLICATION FILED AUG.23,(I920 I Patented Oct. 18, 1921.

6 SHEETS-SHEET l.

6 SHEETS-SHEET 2.

T. C. PARSONS.

BLANK FOR INSURANCE ACCOUNTING.

APPLICATloN FILED AuG.23, 1920. 1,393,823, Patented Oct. 18, 1921.

T. C. PARSONS. BLANK FOR INSURANCE ACCOUNTING..

' APPLICATION man Aue 2s. 1920 1,393,823. Patented Oct. 18, 1921.

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WED- Lumm :IFEM mwst@ RON T. C. PARSONS. BITANK FOR INSURANCE ACCOUNTING.

APPLICATION FILED AUG.23, 1920.

Y Patented 0@t. 1s,1921.

a lSHEETS-SHEET 4.

T. C. PARSONS.

BLANK FoII INSURANCE ACCOUNTING.

APPLICATION FILED AuG.23. 1920.,

y Patented Oct. 18,1921.

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RECAPITULATION 76 PREHIUHS PER ABITRHCT TUTA L?? ABSTRACT DEDUGT TUTA L Puma.

RETURN CONS.

PREMIUHS BYNETCOMNISSIOIS To BALJIIUE AGENT [maren um,

T. C. PARSONS.

BLANK FOR INSURANCE ACCOUNTING.'

APPLICATION FILED AUG.23, 1920. u

Patented Oct.- 18, 1921.

5 SHEETS-SHEET 64 Jnnumnf rale THEDBEASSURANCECO nun" emr/mom.

UNITED STATES THEODORE C. PARSONS, OAK PARK, ILLINOIS.

:BLANK FOR INSURANCE ACCOUNTING.

Specification of Letters Patent.

Patented Oct. 18, 1921.

Application filed August 23, 1920. Serial No. 405,309.

To all whom t may concern Be it known that I, THnoDoRE C. PARSONS, a citizen ot' the United States, and a resident ot (lak Park, in the county otl Cook and State or' Illinois, have invented a new and useful Improvement in Blanks for Insurance Accounting; and I do hereby declare that the following is a full, clear, and exact description ot the same, reference being had to the accompanying drawings, and to the numerals ot reference marked thereon, which form a part ot this speciiication.

T his invention relates to a system of accounting, wherein a central concern deals with numerous agencies and in which accounts between said central concern and the several agencies are balanced at regular periods.

It is an object of this invention to provide a convenient means whereby the central concern may quickly obtain a balance in the accounts between it and the agencies.r

It is also an object ot this invention toV provide a means whereby the central agency may render to the local agents a, statement o account on which the local agent may enter certain additional figures.

A further object of this invention is to provide a set ot blanks whereby the business between the central concern and the local agents may be conveniently conducted, which blanks are adapted to the use of bookkeeping machines in theoiiice of the central concern.

lt is a further object ot this invention to so prepare the blanks that they may be readily used with carbon paper to avoid the necessity ot frequent copyingof data onto different records.

Other and 'further important objects ot` to coperate with the agents accounts current sheet, illustrated in'lligs. l and la.

Fig. i is an illustration of the agents accounts current sheet, superposed upon the agents register sheetas the two would be placed in making certain entries.

Fig. 5 is a viewot' the agents credit memorandum blank superposed upon the agents accounts current sheet as the two would be placed in making certain entries.

As shown on the drawings:

ln Fig. l the agents accounts current sheet is shown as having a heading l, with a blank 2 for the month, and a blank 3 for the year. The heading` also has at Li the name ot the central concern and at 5 the name ot the insurance company with whose policies the records on said blank are concerned. nt 6 is a heading with a blank for the location ot the agency whose data are recorded on said sheet. rEhe agents accounts current sheet is divided into two portions by a central line 7 The lett hand portion of this sheet has a heading 8 to indicate the nature ot the risks underwritten by the policies recorded on this portion of the sheet. It is intendedv that other sheets, headed with the name et they same company and agency, shall be used for other classes of insurance.

The lett hand column 9 ot this sheet has the heading l0, indicating` that the numbers ot the policies are to be found in this column. li the business is properly conducted the spaces opposite these numbers will be tilled in consecutive order, consequently any empty spaces will indicate that a policy form has not beenaccounted for by the agent and will call attention to the irregularity. The next column il is for the entry or the month as is indicated by the heading l2. The next column 13 is tor the entry of the amount ot policy as is indicated by the heading la. The headingl5 applies to all of' the columns from 16 to 19 inclusive, and indicates that they contain premiums. Each oi these columns except 19 is headed as indicated at 20 by figures indicating a rate per cent. These iigures show the rate at which the agent is entitled to charge commission upon the premium in the column be neath each figure. The last column 19 has at its hea-d no indication ot a rate per cent. but only a blank space. This column is for the premiums on which the agent is entitled to an unusual or eXtra commission and not all of the premiums included in this column are to have the commission computed at the same rate.

A space is provided at the bottom of each column for the total of the entries therein as is indicated by the designation 21,Fig. la. 1f the entries for the month occupy more than one page this total can be carried forward and this is indicated by the designation 22. The opposite face of the sheet can be used for this purpose. 1f the figures recorded upon the sheet do not suffice to fill a whole column, there is no objection to entering the totals at a higher point as indicated at 2 3, Fig. 1.

On the right hand side of the sheet is the heading Recapitulation at 24. On this portion of the sheet there is a column 25 headed as is shown at 26 by indicia intended to stand for rate of per cent. of commission and the various lines in this column contain designations 27 for the corresponding lines in the adjacent columns, showing that these lines receive entries of commission at the several rates of per cent.

To the left of column 25 in a column 28 are entered the totals 23, from the columns 16 to 19 inclusive, as is indicated by the heading` Gross Premiums at 29. This column also has an insignia 30 to indicate that debtoritems are there entered.

To the right of column 25 is a column 3l. for the entry of the commissions computed as indicated. The heading 32 shows the nature of the entries and the heading 33 shows that they are credit entries. A space is pre vided at the foot of column 30 for the entry of the total 34 of the items in this column, and a space is provided at the foot of column 31 for the total 35 of the entries in this column. The nature of these sums is indicated by the legends 36 and 37 respectively.

` Atthe bottom of the right hand side of the agents accounts current sheet, is a portion 38 headed by a title 39 which indicat-e5 that this portion is to be used for the record of policies canceled. This portion is divided in a way analogous to the left hand portion of the sheet. The divisions have corresponding; designations. The divisions and the designations are indicated by refer once numerals a() to 54 respectively, which have similar meaning to the corresponding reference numerals beginning with 9 in the left hand portion of the sheet.

The entries in this portion of the sheet should ce made in a distinctive color and the headings and rulings for these columns should be in that color in order that the entries therein may not by any accident be confused with the entries on the left hand portion of the sheet. This is indicated on f the drawinfw bv makinoa these items in obb .g z:

lique lettering while other entries are shown in upright lettering.

Immediately below the portion of the recapitulation table, described heretofore, is another portion which is for the summary of the items concerning the policies canceled. This constitutes the middle section of the recapitulation part of the sheet. The lowest section of the recapitulation part of the sheet will be described later, after the blank for the agents credit memorandum has been described. The column 55 at the left of the central portion of the recapitulation table is for the entry of the total of columns 47 to 50 inclusive, which is indicated by the heading 56. This column and its heading does not stand immediately under the column 28 but is placed to the left thereof in order that the entries to be made therein shall not occupy the space between the total of column 28 and the total of column 55. The latter total is placed to the right of the bottom of column as indicated at 57. The designation showing the nature of this total and the direction to deduct it from the total above are in the place which the total would ordinarily occupy directly under the column 55, as shown at 58. A rate of per cent. is indicated opposite each line, of 55 as shown by 59, to indicate the rate at which the commission on the several premiums should be computed. The commissions thus computed are shown in column under the heading 6l indicating that these are commissions which because the insurance has been canceled -must be returned. The column 60 is not 35, the difference is shown at 65, just as the difference between the total 34: and the total 57 is shown at 64. The spaces for these differences are designated as shown at 67 and 66 respectively, to show the nature of the amounts therein. The amount due the company or due the agent as the case may be is found by subtracting one of these two numhers 64 and 65 from the Iother and is placed at 7() or at corresponding place to the lef of as the case may be. The places for this final result are designated as shown at 68 and 69.

The agents register sheet, shown in Fig. 2, is headed by the name ofthe agency and the name of the agent as indicated at 7l and 712L respectively. The sheet is divided into two parts by the line 72. The left hand part is designated at 73 to indicate that it is for policies written and the right hand side has the designation 74 showing that it is for policies canceled. The remainder or the designations are like those already described under the corresponding titles upon the agents accounts current sheet. The left hand portion of the agents accounts current sheethas rulings which will register with the rulings upon the left hand portion of the agents register sheet. The vertical rulings upon the right hand side of the agents accounts current sheet will at the same time register with these rulings upon the right hand half of the' agents register sheet, but the horizontal rulings and the heading upon the two halves of the agents accounts current sheet will not all register with the corresponding headings and rulings upon the agents register sheet at the same time. The agents accounts current sheet must be differently positioned upon the agents register sheet for entries upon each side of the center vertical line. This is no disadvantage because each accounts current sheet is placed in the bookkeeping machine at the time the information to be entered thereon is obtained from the daily report of the agent and the accounts current sheet as well as the agents register sheet is returned to its place in a loose leaf binder or other file after each entry. Since it is necessary to reposition the agents accounts current sheet upon its respective agents register sheet for each entry, there would be no time saved by having the rulings on the two sides of the vertical central line in register at the same time. As the several headings for columns upon the agents register sheet are like the corresponding headings upon the agents accounts current sheet, there is no need for repeating the particular description of them.

The agents credit memorandum blank is shown in Figs. 3 and 3 and is ldivided vertically into two portions by a line 108 ot' perforations enabling the two parts to be read-V ily separa-ted. The upper part of the right hand portion has a heading 75 to indicate the location of the agency. Below this is a heading 76 corresponding to the heading 2a upon the agents accounts current sheet. The space below this heading contains colA umns and designations like those found on the agents accounts current sheet indicated by the reference numerals from 25 to and below this there is on the right hand part or the agents credit memorandum blank a set of spaces, columns and designations like those on the agents accounts current Vsheet in the places marked by reference characters A56 to 70. These columns and designations are located in the same relative position and are of the same size as the corresponding columns and designations on the agcnts accounts current sheet so that when the two are superposed the upper right hand part of the agents credit memorandum blank will register with the upper right hand part of the agents accounts current sheet.

The left hand part of the agents credit memorandum blank contains at the top a blankV for the entry ofthe month 77. There is also at the top ot this sheet a set ot direc tions 78 indicating that the lett hand portion of the agents credit memorandum blank is to be returned to the central concern. The sheet also contains at 79 directions V'or its use and directions that the statement accompanying the sheet is not to be returned to the central concern but is to be retained by the agent. The tabular portion ot the lett hand part of the sheet has ,the heading Credit Memo. at 8() indicating that it is to be used for a statement ot items ot the agents business not included in the statement rendered by the central concern. Below this is a set of columns, the first one Si having at 82 a heading Policy No.. indicating that this column is to be used "r'or the entry of the numbers of policies mentioned in this memorandum. The next two col.- umns 83 and 85 have at Stand S6 the headings Date and Gross liet. Prem. and have the combined heading Cancellations or Rebate, at 87. Below the column 85 is a space with the designation at 88 Total Gross Ret. Prems., the headings Jfor these columns and the designa-tions just mentioned are printed in a distinctive color to indicate that therv are related to items that will cause the balance due from the agent to the central concern to be smaller than shown by the agents account current as made out at the central agency. The next two columns are given the common heading 88n1 Premiums or Ad( "1. Prem., indicating that they are for pre-- miums or for additional premiums. first ot these. columns indicates the rate per cent. for computing the commission and the neXt column indicates the premium and they/have headings showing their purpose. These headings are shown by numbers 89 and 90. At the foot of column 90 isa space 91 for the total thereof and this is desig nated by the designation 92. Below this is space 94 to receive the total or" the commis sions computed by the rates indicated in column 89. This and the 'fact that it is to be subtracted is indicated by the designation 93. The result of this subtraction stands at 95 directly under a space 96 designated to indicate that the entry therein is the balance due the company as per `statement attached. This space contains an entry equal to the entry shown at the spat-e7() on the agents account current sheet. The designations and rulings indicated by the reference characters from SS'to 95 inclusive are in the same coior as the designation of space 9G which is the The same'as the entries on the left hand part of the agents account current 4sheet as is indicated by the upright style of the lettering. Directly under the space 8S is a space 97 with the designation 96, showing that it contains the total of the commissions on the returned premiums. The designation also indicates that this is to be subtracted. At the right of the space 97 is a space 98 in which the results ot this subtraction is written. This is the first of a list or" items to be credited to the agent. The designation of all of' this list is printed in the saine color as the heading 87.

Beneath the designation 96 there is a series oi" designations 97"L to indicate the nature of each of a list of items. These are for the correction of' inaccurate charges concerning the commissions on policies already report-ed or for other corrections needed to adjust the months balance. These may be either additive or substractive. When the latter, they are indicated by encircling the amount as shown at 98?. At 99 there is a space for the entry of the total ot all the agents charges. There is a designation 100 adjacent the same to show its nature and also to indicate that it is to be subtracted from the figure just above atV 101. These figures were obtained by adding the figures at 95 to those at 96 as indicated by the directions in the designation 102. At 103 the result of rthe whole of this computation is indicated and the designation showing that this is the result is found at 104. At 105 there is a space for the date and at 106 a space 'for the signature of the agent, each of the spaces being suitably designated to indicate its purpose. Below this there is a space 107 for the name and the addressv of the agent. T he space 77 for the month, and the space 107 for the naine and address of the agent as indicated by the designation 107a will register with a space similarly designated, upon the other face of the right hand part of the agents credit memorandum' statement when the sheet is folded. The last named designation does not show inthe drawing. Y

The system in which these papers are used contemplates the employment of bookkeeping machines and of machines operated by punched cards for tabulating the results. At the beginning of the month, the work is begun by filling in the headings at the top of the agents accounts current sheet' and the agents `register sheet.

There is a set of these sheets .for each agent and, when the central concern isthe joint activity of several insurance companies,` if any agent acts for more than one company, there will be la corresponding number of accounts current sheets and of agents register sheets, for that agent. The agents accounts current sheets are filed loosely but theV agents register sheets are kept in loose leaf binders, one for each company or if the business is large enough a set for each company, a set being one register for each district.

When a report is received from an agent indicating that a policy has been written, the agents accounts current sheet is taken from the file of the said sheets, and the agents register sheet is taken from its place in the loose leaf binder and the two sheets are placed in the bookkeeping machine with agents accounts current sheet superposed upon the agents register sheet so that the spaces for the entries concerning this insurance shall registerl as shown in Fig. 4. Carbon paper 150 is placed between these sheets and the entries concerning the policy reported by the agent are made in their proper places The papers are then returned to their respective places inthe file of accounts current and in the agents register. When another report is received from the same agent this operationis repeated with `the same sheets and separate set of entries is made for each policyreported. When the report shows Athat a policy hasbeen canceled the agents accounts current sheet and the agents register sheet are placed in the bookkeeping machine so that the portion 3S of the` agents accounts current sheet shall register with the portion forcanceled insurance upon the agents register sheet, with carbon paper between the sheets. 0rdinarily this will require the agents accounts current sheet to be placed higher upon the agents register sheet than when recording the writing of insurance.

As the end of themonth approaches, the blank for the agents credit memorandum is prepared by filling in the heading at and 77. f At the Vend of the month the totals ot columns, 16 to 1,9 and 44 to 50 are found and entered by carbon paper upon the agents register sheet at the same time thaty they are entered upon the agents accounts Vcurrent sheet. The agents accounts current sheet and the agents credit memorandum blank are then placed in register with carbon paper 151 as shown in Fig. 5 and the recapitulation tables are filled out. The result of this operation (shown at 70) is reproduced as shown at 70a at the place in register with 70 upon the right hand part of the agents credit memorandum blank. rlhis sum is copied into the space 96 upon the left hand part of the blank.

The agents accounts current sheet Figs. 1 and 1a and the agents credit memorandum blankFigs. 3 and 3a are then sent to the agent who keeps the accounts current sheet as directed 'by the last line of the legend 79 on the agents credit memorandum blank. The agentthen fills out columns 81 and 83 and enters the amounts under headings 86 or 90 according to whether the insurance in question was canceled or written. In the latter case he fills out the entry under heading 89 but in the former case no corresponding entry is provided for as the central concern already knows what rate of commission should be allowed on canceled insurance. The agent then makes the calculations indicated by the legends 92 and 93, and obtains the figures for the space 95. He then by following the directions 102 obtains the sum 101. By adding the column 85 he obtains the footing 88 and from this subtracts the return commissions as indicated by 96. The result 98 is suitably placed to be added with the rest of the items indicated by 97a. This sum 99, the directions 100 show, must be subtracted to get the corrected balance due the company 103.

The third section of the recapitulation part oi the agents accounts current sheet has a series of designations 109 designating spaces wherein the agent may write a copy of the results of his entries under the designations 9'?a on the agents credit memorandum blank. Spaces 110, 111, and 112 are also provided wherein the results in spaces 95,101 and 99 on the agents credit memorandum blank may be recorded and these spaces are designated to show their purpose. By placing the designations 109 so that their entries come under column 25 the spaces 110, 111, and 112 naturally come under the space 70 and render easy the computation of the corrected balance which is entered at 113. The agent can thus enter on the sheet which he is to retain a copy of the results of the data he has sent to the central concern on the agents credit memorandum blank. The agent then returns the credit memorandum blank to the company and keeps the accounts current sheet for his own file.

The agent reports daily to the central concern the business done that day. Immediately after the records concerning the several policies reported as written or canceled by the agent have been entered by means oi the bookkeeping machines, cards are punched to represent the same data. These cards are used with the card sorting and tabulating machine and the balance obtained by means of these tabulating machines must agree with the balance obtained by the bookkeeping machines. When these agents credit memorandum sheets are returned by them after the end of the month, a similar method to compute the corrected balance is used based upon another set of punched cards, and using the tabulating machines. Thesefcards are punched from the data sent in on the agents credit memorandum blanks.

This system dispenses with the need of deferring the audit `of the agents account until after the end ofthe month. Each daily report of the agents transactions is incorporated intothe 15015316, ,yielded by the bookkeeping and tabulating machines. The check afforded by the fact that these two mechani- 4cal results must agree makes certain that the balance rendered by the central concern to the agent (at and 96) is a correct statement ci" his account as it stands on the books of the central concern. The only matter needing a checktherefore is the correction to the balance caused by the'agent having on his books items not on the books oiE the central concern. These are the items which the agent enters on the agents credit memorandum blank. The audit of these is obtained by the tabulating machines operating on the second set of cards as above explained.

It is evident therefore, that at the end of the month there is very little work leftto do, as compared with what remains at that time under former systems, to arrive at a statement oit thevcondition of the central concerns business. Moreover the use of the tabulating machines permits this remaining work to be very quickly done. The present system thus enables a statement of the condition of the business to be obtained nearly thirty days earlier than under former systems.

It is to beunderstood that wide variations in the details of headings and arrangement of columns may be made without departing from the spirit of this invention, and it is not the intention to limit this patent to such details of headings or arrangements otherwise than is necessary because of the prior art.v

I claim as my invention:

1. A sheet having a field designated to receive data concerning insurance written, containing a set of columns each designated by the indication of a rate of per cent., the set as a whole being designated to4 indicate that the several columns are to receive premiums, a space adjacent each column designated to indicate that it is to receive the total of the entries in that column, a second field containing a column designated to indicate that it is to receive said totals, each line of said column being designated by a rate of per cent. and another column designated to indicate that it is to receive commissions and having its lines designated by the same rates per cent., a space adjacent and in alinement with each of said columns each designated to indicate that it is to receive the total of its column, a third field containing columns and spaces similar to the iirst lield and a fourth lield containing columns and spaces similar to the second ield, the columns of the fourth vfield being adjacent to but out of alinement with the total spaces of the second `field, being separated by a greater distance than the columns of the second field whereby they are out of alinement with the columns of the second field, spaces adjacent to but out of alinement with the columns of the fourth field and suitably designated to indicate that they are for the totals of said columns respectively, said total spaces being in alinement with the columns of the second field, whereby the totals of the corresponding columns of the second field and fourth field will be separated by spaces containing no entries.

2. A sheet having two fields each having columns of suitable size to receive data and spaces of suitable location to receive the totals of the data in said columns, said sheet also having a field with two parts, each part containing columns, each column having as many lines as there are columns in one of the first named fields, corresponding lines in the columns in the two parts bearing'like designations, each column in each of the first named two fields having a designation like that of the corresponding line in the third field, each part also having for each column a space suitably located to receive the total of said column, Vthe columns in one of said parts being separated more widely than the columns in the other part but the spaces for totals being the same distance apart in each part whereby the totals are conveniently located for computation.

3. A sheet having two fields each having columns of suitable size to receive data and spaces of suitable location to receive the totals of the data in said columns, said sheet also having a field with two parts, each part containing columns, each column having as many lines as there are columns lin one of said first named fields, corresponding lines lin the columns inthe two parts bearing like Y designations, each column in each of the first named two fields having a designation like that of the corresponding line in the third field, each part also having foreach column a space suitably located to receive the total of said column, the columns in one of said parts being separated more widely than the columns in the other part but the spaces for totals being thesame distance apart inw each part whereby the totals are conveniently located for computation, in combination with a sheet having a tabular field like said third field andV another field, spaces in said last named eld suitably designated to receive data showing how the result computed from the totals in said third field should be adjustedk and suitably designated spaces in said last named eld for computing the said adjustment, spaces adjacent said tabular field suitably designated to receive the result of said computation, said first named sheet havinga fourth field containing suitably designated spaces for the recording of the items entering into said adjustment.

4; A sheet having a field designated to receive data concerning insurance written, containing'aset of columns each designated b v the indication of a rateof per cent., the set i165 j as a whole'being designated to indicate that the several columns are to receive premiums, a'space adjacent each column designated te indicate that it is to receive the total of the entries in that column, a second field containing a column designated to indicate that it is to receive said totals, each line of said column being designated by a rate of per cent. and another column designated to indicate that it is to receive commissions and having its lines designated by the saine rates per cent., a space adjacent and in alinement with each of said columns each designated to indicate that it is to receive Vthe total of its column, a third field containing columns and spaces similar to the first field and a fourth field containing columnsand spaces similar to the second field, thecolumns of the fourth field being adjacent torbut out of alinement with the total spaces of the second field, being separated by a greater distance than the columns of the second field, whereby they are out of alinement with the columns of the second field, spaces adjacent to but out of alinement with the columns of the fourth field and suitably designated' to indicate that they are for the totals of said columns respectively, said total spaces being inalinement with the columns of the second field whereby the totals of the corresponding columns of the second field and fourth field will be separated by spaces containing no entries, in combination with a second sheet containing columns and spaces like those in the second and fourth fields of the first menT tioned sheet, having similar designations and being suitably located to register with the' columns and spaces of the second and fourth fields when said sheets are superposed, said secondl sheet also containing spacesV suitably designated and arranged for the computation of a correction of the resultcomputed in said second and fourth fields, there being on'said first sheet a fifth 4 field containing suitably designated spaces for the insertion of the'data on which such ycomputation is founded and a suitably designated space for the corrected result.

V5. A sheet having a field designated to receive data concerning insurance Written, containino' a set of columns each designated by the indication of a rate of per cent., the set `as a whole being designated to indicate that Vcolumn being designated by a rate of per cent. and another column designated to indicate thaty it is to receive commissions and having its lines designated by the same rates per cent.'a space adjacent and in alinement with each of said columns each designated to indicate that it is to receive the total of its column, a third ield containing columns and spaces similar to the first ield and a fourth field containing columns and spaces similar to the second held, the columns otl the Jfourth lield being adjacent to but out of alinement with the total spaces of the second llield, being separated by a greater distance than the columns of the second field, whereby they are out of alinement with the columns of the second lield, spaces adjacent to but out oi alinement with the columns of the fourth field and suitably designated to indicate that they are for the totals of said columns respectively, said total spaces being in alinement with the columns oit the'second field whereby the totals of the corresponding columns of the second -eld and fourth lield will be separated by spaces containing no entries, in combination with a second sheet containing' columns and spaces like those in the second and fourth lields of the first mentioned sheet, having similar designations and being suitably located to register with the columns and spaces of the second and fourth lields when said sheets are superposed, said second sheet also containing spaces suitably designated and arranged for the computation of a correction of the result computed in said second and fourth fields, there being on said first sheet a lith lield containing suitably designated spaces for the insertion of the data on which such computation is founded and a suitably designated space for the corrected result, the portion of said second sheet like said second and fourth fields being separated from the portion for computing the correction by a weakened line whereby it may be readily detached therefrom.

In testimony whereof I have hereunto sub scribed my name in the pr-esence of two subscribing Witnesses.

THEODORE C. PARSONS.

Witnesses:

FRED E. PAESLER, W. H. WHITTEN, Jr. 

